Global Health

Its been a very exciting year, working as a Global Health Corp. When i joined, i wanted to bring my passion for Health and ICTs close together, and to experience the world of Global Health. What does it really mean to be part of a global health movement? I am still learning.

At the GHC institute in Yale, I face 2 men – 2 gay men, 2 HIV positive gay men – and they communicated to me. 9 months later, my government passed the anti-gay law, and it makes it criminal for these men to step on the soils of my motherland to communicate to young people, like me about what it means to be the poster child for an AIDS epidemic, and how to overcome all odds to create a movement.

In South Western Uganda, I learned about Ariel Clubs, groups of young people who are HIV positive. And i learned to listen to them as they told me stories of how they learned about their HIV status. and how they have managed since. They are vibrant, they are confident and they are a force to reckon with. They are a movement. And then 3 weeks ago, my government passed a bill that will effectively keep away every young person who doesn’t already know their status. because, knowing your status can now be a precondition for going to jail, depending on how your life pans out.

In working around HIV and AIDS, I have learned lots of things – some I knew, some are new. But I have observed and learned that there is a scarcity of health workers in the HIV/AIDS Clinics in public health facilities. There are a few, who brave the long lines of patients, who sit in on trainings and learn about the latest treatment guidelines, and they go down to the nearest HC III and begin to implement these. And then, a nurse gets sent to jail for a needle stick injury – her major undoing being that she is HIV positive. The victim on the accident was placed on PEP and has remained negative, and indeed, her professional mistakes were not excusable, but neither did the professional council prevail over her and her employer, instead, criminal law was called upon. With a national prevalence of over 7%, are we going to hire only HIV negative health workers? I wonder. And what do we make of the movement of peer educators who are part of the system for care and follow-up of HIV patients across the country?

I am a Global Health Corp – once a fellow, always a fellow!

I may be winding up the fellowship, but my consciousness of the health challenges around me is not waning. There’s Tobacco to deal with (and how young people in Bushenyi leave school to go pluck leaves, effectively turning themselves into MARPs on pay-day); and we now know that TB and HIV are such a deadly mix.

There is the road menace we have invented – number of Boda Boda related accidents! So many young people, in the prime of their lives, are screeched to a near-death experience on these 2 wheelers. Rules dont seem to work, maybe we start a movement!

There is Female Genital Mutilation in Eastern Uganda – as a father of girls, this shakes me to the core every time i think about it. Yet, many school girls still face the barbaric act.

How about Teenage pregnancies? And the unmet need for family planning. How about Sexual and Reproductive Health and Rights knowledge gaps? Or the increasing consumption of drugs among the young male populations in Uganda’s urban communities.

What about you – when did you last test for HIV? If you are sexually active, do you use protection? Ladies, what is your smart choice, to prevent an unwanted pregnancy? Mothers, have you given your under 5s the gift of a complete immunization?

30 year old Jessica (not real names) is a single mother of a 4 year old gal, and a 2 year old boy. She grew up in the hills near Kabale, in what she calls a “proper christian home with strict parents.” The second of 5 children, Jessica lives with her mother, having lost her father as early as 1990. The 5th wife of her husband, Jessica conceived within the first year of her marriage, only getting knowledge of her HIV status in her 1st trimester. Jessica lost no time in getting into ART Care and Therapy.

In 2009, having been exposed to PMTCT services, Jessica delivered her first born daughter, HIV Negative. Excited at the possibility, Jessica knew she could hold onto her dream of having a family, and in 2011, Jessica delivered her second child, HIV Negative. Jessica is one of hundreds of thousands of women who have seen the fruits of the intervention to prevent the transmission of HIV virus from a mother to her unborn child.

When my organization, the Elizabeth Glaser Pediatric AIDS Foundation started to implement the USAID funded STAR-SW, there were only 100 accredited sites to offer PMTCT services in 13 districts in the South Western region of Uganda. Today, there are over 220 PMTCT accredited sites.

Today, the problem of health workforce is not in the numbers, rather in their technical capacity to support fully the elimination of mother to child transmission of HIV (eMTCT). And whether this capacity is well harnessed and managed so that every mother who comes to the facility will find a competently equipped health worker to attend to them. Where the numbers remain wanting, Peer educators have been used to stop gap non-technical areas, so that the few health workers present could be utilized maximally. There are many facilities that could use peer educators, in some cases, needing upto 6 in the HIV/ART Clinic.

For health workers to be present, without the logistics they need to perform their work is disheartening. eMTCT programs are premised on the presence of HIV Test kits, the presence of ARVs pre and post-delivery, both for mother and baby. Incidentally, mothers can be initiated on ART Care without the presence of complex and expensive equipment in a state of the art laboratory. But whenever a facility does not have these essentials, then the consistency of the intervention is greatly undermined. The question of logistics has a flip side, whether a health center is an accredited site to receive and offer PMTCT services. While I understand the dynamics of this, I also realize that the size of pandemic that HIV is, that we should indeed consider to have this intervention at the nearest health facility to a mother who we would not like to deliver at home, unattended to, and who will inadvertently pass the HIV virus to her unborn child.

South Western Uganda communities also have taught me an important lesson – that when men are not involved in the seeking of eMTCT services, then we do not have a sustainable intervention. Men are key, and in some cases kings. But men have escorted their pregnant partners to the facility only to sit under a tree for 2 or 3 hours, unattended to and completely detached from the details of an ANC visit. Indeed, some health workers do not know what to do for men, other than HCT for which couple testing is rewarded with a certificate. There must be, on offer, a package suited towards men that will give them a sense of belonging and connection to the health care of their HIV positive partner, beyond HCT. Here, is opportunity for innovation.

Often, when HIV positive mothers leave the facility, they go into a stigmatized community and some of them are lost to care and treatment at the facility. We need to continue to take a detailed look at the linkages between the facilities and the communities. The use of peer educators could be a terrific solution for this. For example, staff at Ntungamo district’s Itojo Hospital have devised a plan, to assign each peer between 5-6 mothers who live in the same neighbourhood as they do. They will check on them at home, and ensure that they remain plugged into Care and Treatment; and in some cases serve as treatment buddies.

But we can do so much more with community leaders – parish chiefs, religious leaders, sub-county chiefs, model men, opinion leaders – they can all help to shape a dialogue, at community level that will stem so many negative attitudes and cause us to

To date, we have seen over 2 million mothers access and receive PMTCT services, but we cannot remain complacent, the next mother in line is equally as important as the one we have served. And we are going to need all hands on deck, Men, trained health workers, adequate supplies, and a conducive environment. Together, we can bring about an HIV Free generation, together, we can eliminate mother to child transmission of HIV.

In the world of software, your best bet is open source software – usually – because, it comes free, has been developed by a community, and everyone working on it, depends on everyone else to review what they are doing to make it better. You tend to get the most original ideas, refined by the most creative minds, who have the most nobel motivations. Even if you have been living under a rock, you have heard of the popular Open Source Operating Systems (Ubuntu, RedHat, CENTOs), Office Suites (LibreOffice and OpenOffice), Mobile OS (Android) and some of the coolest tools in the technology world today (Linux Core, Apache, PHP, BIND.

If you have sent an email before, there is a very strong likelihood you used one of the 70% Servers running Apache. And you are reading this, most likely, because DNS is working fine, for you to get from your local subnet onto the internet.

At the core of it, these cool tools are developed using the “open source model” – open source as a development model promotes:

Universal access via free license to a product’s design or blueprint, and

Universal redistribution of that design or blueprint, including subsequent improvements to it by anyone

A more academic definition of Free Software is: “Free software” is a matter of liberty, not price. To understand the concept, you should think of “free” as in “free speech”, not as in “free beer”. (Source) Freedom 1 (the second) has a precondition, to have access to the source code – that makes it opensource.

But is there such a thing as open source, outside of software?

Yes. We can engage aspects of life – all of life – “the open source way”.

Imagine a global understanding towards expressing a desire and willingness to share, to collaborate with others transparently. Imagine an understanding where failure is seen as a means to improve, and where all of us are constantly looking to improve. Where we go out of our way to make others better at what they are doing.

For the last 9 months, I took a break from the confines of the server room, to join the Global Health Corps. I feel like GHC, in many ways, is open-sourcing a new kind of work force to fight global health inequalities. ICT experts, architects, accountants, public health specialists, fresh graduates, you name it – all of us can contribute to the global health equity movement. The solutions are no-longer churned out only in medical school, they are traversing the globe in all sorts of shapes and forms and careers.

This is the very core of the post 2015 agenda. The Sustainable Development Goal proposed for Health is – Achieve Health
and Well-being At All Ages – To achieve this Universal Health Coverage, there are 4 underlying principles to think about:

The Life Course Approach

Primary Health Care a Priority

Action on Determinants Through Multi-sectoral Initiatives

The 3rd one is critical to the future of health care. We cannot leave the future of our health care to only “medical experts”. We all need to roll up our sleeves and dive in.

Household Sanitation is not going to be the preserve of the Village Health Team, that is yours to deal with, that;s for you to teach the little ones. Out-of-pocket spending on health care, as a measure of household incomes – that is for health economists and policy analysts to decipher. Drug stocks, lets get managers into health facilities to streamline business processes to near perfection, and lets get more doctors into the labour suite – no mother should die while delivering, let alone, without the hands of a skilled health worker. And lets get Architects to build ‘healthy’ buildings; accounts, to manage facility and sector grants.

Lets get you to find how you can be a part of this process, and when we all curve out our niche, lets do it the open source way.

The Open Source way means we all commit to play an active role in improving the world, which is possible only when everyone has access to the way that world is designed. The world is broken in many places, but, together, we can all design the best parts of the world, and open source them to the utmost end of the world.

The world is full of “source code”—best practices, blueprints, guidelines, recipes, rules —that shape the way we think and act in it. I believe this underlying source code (whatever its form) should be open, accessible, and share-able!

15 The LORD God took the man and put him in the garden of Eden to work it and keep it. 16 And the LORD God commanded the man, saying, “You may surely eat of every tree of the garden…

This morning, i read the story of my good friend Sam Agona lamenting the new war of Northern Uganda – the Sex War – but the thing that caught my gasping attention was the mention of young gals who are facing the sexual front, with multiple partners, and using unsafe means, under the illusion that HIV will not kill them, if they have access to the right drugs.

This notion is galvanized, in part by Noerine Kaleeba‘s TASO Service Center in the bustling northern city, once the safest haven from the marauding LRA. Opened in 2004, the center operates in the heart of the Northern Uganda. During the time of insurgency, most of the population was living in Internally Displaced people’s Camps. The center had to offer services in a camp setting. With more people living in small grass thatched houses and associated poor living conditions, there was high HIV/AIDS prevalence in the region.

So am all packed up and ready to head home – after 15days at the GHC Training Institute, hosted at the famed Yale University. This past few days, my cheese has moved, in interactions with great people like Barbara Bush, Havard Business School’s Rob Kaplan, and Phil Wilson of the Black AIDS Institute.

And my life has been dramatically changed! I am a Global Health Corp – or rather, simply put:

I belong to a community of young passionate leaders who, now more strongly than ever before, share a common belief that Health is a Human Right. And I believe that I have my own share of the work to use social justice to being about Health Equity.

I embrace the philosophy of active problem solving, and engaging global partnerships in order to bring about real and sustainable change. I need the complete spectrum of life itself, in skills, experiences, and perspectives from people like you in order bring about a serious change in global health.

Architects, Nurses, Computer Scientists and people like You from allover the world – break down walls to unite and enact expertise from all disciplines and backgrounds. Together, we support Global Health Equity Movement.

I am a Challengers, I am a Thinkers, and I am a Change Maker. I am, a Global Health Corp.